Thursday, 23 April 2009

Sex

Can people have sex?

Well, yes. Obviously. Or we'd not be here and the world'd be an emptier place. But, if there weren't people then there wouldn't be Pot Noodle, so it wouldn't be all bad.

I chanced upon an article in Slate Magazine today, because I was looking for information on sex. It's with hindsight that it dawned on me that Googling (is that a verb?) for "sex" at work may raise a few eyebrows when the IT server guys see what I came up with. My, human creativity really does know no bounds. I'm so glad I did it all on someone else's computer.

The rationale for finding oh so many sites of oh so many obliging women? Because I don't know enough about sex and older people. Always one to value CPD and a thirst for knowledge and self directed learning, I assiduously studied all I could, online.

Better still, the whole team poured over it all. We didn't learn a lot. I did learn that some of my colleagues know far too much about obscure specialist subjects.

Back to the reason for our diligent search. Sex. Can older people do it?

Really, can they?

No no no, not in a sweaty, physical, swinging from the chandaliers sort of way. In a legal, "Are they allowed to?" sort of way. A tricky matter to disentangle. Googling found far more sites of scantily clad ladies of a certain age than it did of learned legal discourse. There were of course some sites dedicated to lusty, obliging women. And sites dedicated to lawyers. All from the same search. I guess lawyers and prostitutes have more in common than one may first imagine, seeking to use their skills to satisfy their clients for significant amounts of cash.

We've a lady in a care home. She holds hands with a man. They kiss and cuddle. They're both widowed, so single. They're both demented, and are incapacitated adults (within the meaning of the Mental Capacity Act 2005, with respect to the decision of an intimate relationship). They like to sleep together. They've sought to have a sexual relationship together.

MCA 2005 directs what can and can't happen, about a great many things (e.g. marriage) but not specifically about sex. Neither does the European Convention of Human Rights, that we could find. Nor did any guidance we rummaged around, on such sites that weren't gloriously lurid.

So, the question remains unanswered. And care homes in my corner take very different views on it "meddling" as they feel wont to do. A definitive answer 'pon desire is desirable. Do older adults have a right to sex?

10 comments:

A few years back I received a pair of crotchless panties for xmas from a very respectable friend of mine, she was 75 or so at the time. Said panties had been bought for her as a gift by a gentleman with, um, a gentleman's grasp of ladies clothing sizes. The original recipient took one look and knew I was the only person they'd fit!I'm comforted by such experiences and the wisdom of my friend who says she has more and better sex now she is over 70 than she ever did. No pressures of children or ageing parents to care for, loss of inhibitions and more free time all make her sex life better. I know from her gossip that she's not alone, the vast majority of her friends are similarly engaged.

I can't comment on the law, or the ethics but seems to me that just because people are demented it doesn't mean they don't know what feels good. Many people still believe that younger adults with learning disabilities shouldn't have sexual relationships despite the desires of those people themselves. Perhaps in time sexuality and need for sexual pleasure will be recognised as a right for all humans regardless of disability. Bendy Girl

The right to have sexual relationships does not disappear with capacity. Children may not like the idea but that isn't necessarily anything to do with the capacity or not. If you are looking at best interests again, it's hard to argue that it wouldn't be in their best interests unless there was previous knowledge of a religious conviction or way of life prior to developing dementia.

we had a not-entirely-similar situation a few months ago when I we established that a woman who had been in a long term relationship prior to developing dementia could maintain regular undisturbed visits from her partner in her residential care home. Of course, it wasn't a difficult decision to make as there had been an established relationship previously but it seemed to need the involvement of a lot of people to even establish that much.

Dr Grumble, thank you - we have indeed discussed that (and it sparked local dialogue since it was contentious as to how involved CPNs became in facilitating prostitutes for LD patients).

BG, I speak about sex with my patients firstly since it's important to many of them, secondly because illness can affect it and thirdly 'cause my medications can so I need to know about that. I agree with you - many older adults describe a good/better sex life that's important to them. The nuisance is, in your last paragraph, how the law or guidance codifies this (or doesn't) since care homes invariably want, "None of that shennanigans under my roof!"

JD, indeed. Of course they should. But it's how our team can challenge restrictive practices with more credbile authority than "Because we say so!"Although most dementia hits the limbic system before hitting declarative memory, folk with frontal lobe problems (which is 1 in 4 of early onset dementia) have loss of inhibition. Although loss of libido is therefore common, for some folk it's the opposite, with a zesty enthusiasm to do what so ever they wish.

There're slightly over 2000 Care Home beds in my corner. Crunching the numbers, even if just 3.2% had a desire for sex, that'd average at least one resident in every Care Home in the district.

CB it's fairly clear (but as you say, often resisted) if it's an incapacitated resident who's got a longstanding relationship. In those who don't it's much worse. We've tried Best Interest meetings but couldn't evidence what past wishes or current views would be, or what benefits/consequences would be to each option that generates a choice that everyone (including the Care Home manager) recognised was clearly in their best interests.

Hence my desire for a law or guidance on if there's a "right" to this.

I'm not sure what the legal answer is, but it seems wrong to prohibit it so long as both parties are willing participants. It's natural, and our professors tell us that sexual desire and activity don't really decline substantially until late 70s/early 80s so it's normal behaviour for the population.

Hmmm. Interesting post, has got my rather out of practice mind "grinding the gears" as it were. I really should be Precis-ing an article on Schizophrenia, but this is on my mind, so post I shall!

In the case of a couple forming after the onset of dementia, and when classed as "vunerable adults", do we have a responsibility to protect them in that area? Do the families have a say?

I'm not sure. I would be concerned about possible accusations of abuse [most probably made by embarressed family members], or if the sexual attention was directed at more than one person.

If my grandparents were to be in this situation and find a loving, rewarding relationship with their chosen companion, then good on them. Would I want to know the nitty-gritty details? No thank you. I would want them to have privacy, dignity, and not have their sex lives monitored as if they were a pair of naughty teenagers.

However, what if one person in this couple had capacity, and the other did not?

Why Lake Cocytus?

Dante's "Inferno" takes us on a journey through to the deepest layer of Hell, passing down through layers of fire. Within this Ninth Layer there is no flame, there is a lake of ice. Imprisoned within this are the those of greatest evil, those of greatest betrayal. Rather a puzzle to me, this one. Is it a terrible place, manifesting evil incarnate? Or is Lake Cocytus a good thing, containing the world's greatest evils?

Good or evil this place, this Lake Cocytus, is my space to entomb the thoughts and musings best interred in ice.

"Because love is not sex or a shared faith, or the 'joint maintenance of a household and the upbringing of children'."
- Sergei Lukyanenko

"Look at that. Look at that. "Accident Blackspot"? These aren't accidents. They're throwing themselves into the road gladly. Throwing themselves into the road to escape all this hideousness."
- Withnail & I

"We know what happens to people who stay in the middle of the road. They get run down."
- Aneurin Bevan